Search Results (84)

Biofilms are structured communities of microorganisms encased in a self-produced extracellular matrix, and they represent one of the most widespread forms of microbial life on Earth. Their presence poses serious challenges in both environmental and clinical settings. In natural and industrial systems, biofilms contribute to water contamination, pipeline corrosion, and biofouling. Clinically, biofilm-associated infections are responsible for approximately 80% of all microbial infections, including endocarditis, osteomyelitis, cystic fibrosis, and chronic sinusitis. A particularly critical concern is their colonization of medical devices, where biofilms can lead to chronic infections, implant failure, and increased mortality. Implantable devices, such as orthopedic implants, cardiac pacemakers, cochlear implants, urinary catheters, and hernia meshes, are highly susceptible to microbial attachment and biofilm development. These infections are often recalcitrant to conventional antibiotics and frequently necessitate surgical revision. In the United States, over 500,000 biofilm-related implant infections occur annually, with prosthetic joint infections alone projected to incur revision surgery costs exceeding USD 500 million per year—a figure expected to rise to USD 1.62 billion by 2030. To address these challenges, surface modification of medical devices has emerged as a promising strategy to prevent bacterial adhesion and biofilm formation. This review focuses on recent advances in chemical surface functionalization using non-antibiotic agents, such as enzymes, chelating agents, quorum sensing quenching factors, biosurfactants, oxidizing compounds and nanoparticles, designed to enhance antifouling and mature biofilm eradication properties. These approaches aim not only to prevent device-associated infections but also to reduce dependence on antibiotics and mitigate the development of antimicrobial resistance. Full article

Titanium (Ti) alloys, renowned for their exceptional physicochemical properties and high biocompatibility, are widely utilized in orthopedic and dental implants; however, their lack of intrinsic antimicrobial activity significantly increases the risk of implant-associated infections, often leading to severe complications and implant failure. Developing antimicrobial coatings on Ti implants is therefore a promising strategy. In this study, tannic acid (TA) coatings were deposited by immersing Ti alloy surfaces—beforehand activated by low-temperature oxygen plasma—in TA solutions at 2, 5, and 8 wt%. Coatings were characterized by scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), water contact angle (WCA) measurements, and Folin–Ciocalteu release assays, and their cytocompatibility and antimicrobial performance were assessed in vitro. Surface characterization confirmed the formation of uniform TA layers, and WCA measurements indicated enhanced hydrophilicity relative to unmodified Ti (82.0° ± 3.6°), with values decreasing as TA concentration increased (from 35.2° ± 3.2° for 2% TA to 26.6° ± 2.8° for 8% TA). TA release profiles exhibited an initial burst followed by sustained diffusion, with 5% and 8% coatings releasing significantly more TA than 2% coatings. Coatings containing ≥ 5% TA demonstrated bactericidal activity—achieving > 2-log₁₀ reductions—against Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, and also showed inhibitory effects against Candida albicans. Importantly, all coatings remained cytocompatible with NIH/3T3 fibroblasts, and the released tannic acid hydrolysis products (particularly gallic acid) enhanced their proliferation. These findings indicate that plasma-activated titanium surfaces coated with ≥5 wt% tannic acid impart broad-spectrum antimicrobial efficacy and hold potential to reduce implant-associated infections and improve long-term outcomes in orthopedic and dental applications. Full article

Background/Objectives: Ketorolac is commonly used for pain management after orthopedic surgery, but concerns regarding its effects on postoperative complications remain. This study evaluates the impact of ketorolac use on short- and long-term outcomes in adult patients undergoing uncemented primary total hip arthroplasty (THA), where implant stability relies on biological fixation through bone ingrowth into a porous-coated prosthesis rather than bone cement. Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Patients aged 18 years or older who underwent uncemented primary THA between 1 January 2004 and 1 January 2024 were included. Two cohorts were compared: those who received ketorolac on the day of or within one week of surgery and those who did not. Cohorts were propensity score-matched. Outcomes were assessed at 30 days, 1 year, and 5 years postoperatively. Results: At 30 days, ketorolac use was associated with significantly lower risks of transfusion (RR: 0.6, p < 0.01). However, it was linked to higher rates of acute posthemorrhagic anemia (RR: 1.2, p < 0.01) and periprosthetic fracture (RR: 1.4, p < 0.01). At 1 year, ketorolac use was associated with reduced risks of death (RR: 0.8, p < 0.01) and transfusion (RR: 0.7, p < 0.01), but increased risks of acute posthemorrhagic anemia (RR: 1.2, p < 0.01), deep surgical site infection (SSI) (RR: 1.8, p = 0.01), superficial SSI (RR: 1.9, p < 0.01), periprosthetic joint infection (RR: 1.1, p < 0.01), wound dehiscence (RR: 1.2, p < 0.01), periprosthetic mechanical complication (RR: 1.2, p < 0.01), and periprosthetic fracture (RR: 1.5, p < 0.01). Conclusions: Our findings highlight the complex risk profile of ketorolac in uncemented THA patients and suggest that clinicians should carefully consider individual patient factors and engage in shared decision-making when counseling patients on the use of ketorolac in the perioperative setting. Full article

Hospital-acquired infections in operating rooms are contributing factors to the increasing presence of pathogens, with surgical site infections being the most frequent among them. Surgical antimicrobial prophylaxis is administered to minimize the risk of developing surgical site infection. Surgeons are responsible for weighing the benefit of surgical site infection-risk reduction for the individual patient afforded by prophylactic antimicrobial administration against the broader societal risk from such use. The aim of this study was to analyze the data on surgical antimicrobial prophylaxis related to patient status, surgery duration, wound classification and the occurrence of surgical site infection in two operating rooms of the Veterinary Teaching Hospital of Naples from January 2023 to January 2024. Two hundred seventy-seven surgical procedures met the inclusion criteria. For soft tissue clean-contaminated procedures and clean orthopedic surgeries not involving implants, no statistically significant difference was observed between the various antibiotic protocols used and surgical site infection; this finding supports the possibility of avoiding antibiotic use for these procedures. In contrast to previous reports, this study identified a statistically significant association between ASA status and surgical site infection; no correlation was found between surgical duration and the occurrence of infection. Further research on antibiotic use and risk factors associated with surgical site infection will be crucial to strengthen clinical guidelines. Full article

Black phosphorus (BP) nanoflakes have attracted interest as an antimicrobial material for wound healing and implant-associated infections due to their bactericidal activity without the use of antibiotics. Hydrogels are frequently used as a delivery system; however, most research uses photonic activation in the form of near-infrared (NIR) laser stimulation to cause rapid BP degradation, reactive oxygen species (ROS) generation, and a localized photothermal effect. For implant-coating applications, using NIR laser stimulation could be challenging in practice, especially for porous orthopedic implants. This article investigates whether BP nanoflakes, suspended in Pluronic F127 (F127) hydrogels, remain effective against Staphylococcus aureus without photonic activation. The experimental results showed 89.4 ± 7.6% bacterial inhibition from BP nanoflakes at a 5120 µg/mL concentration via passive diffusion in F127; however, it could not kill all the bacteria present. It is hypothesized that the F127 gel interface could create a barrier between the bacteria, which continue to multiply in media, and the antimicrobial black phosphorus compound, which degrades in the F127. Full article

Implant-associated infections (IAIs) are major complications in dental and orthopedic implants, potentially compromising osseointegration and eventually causing implant loosening or removal. Thus, early prevention of bacterial adhesion and biofilm formation is critical for successful long-term osseointegration. Polyetheretherketone (PEEK) exhibits excellent physicochemical properties and an elastic modulus similar to bone tissue, making it a promising material for dental and orthopedic implants. However, its inherent lack of antibacterial properties limits its ability to prevent IAIs. Herein, an antibacterial coating with controlled drug release and excellent biocompatibility is designed by immobilizing minocycline (Mino)-doped carboxymethyl chitosan (CMCS) onto the PEEK surface via a polydopamine (PDA)-mediated Michael addition and Schiff base reaction. The coating is characterized by SEM, XPS, water contact angle measurements, and in vitro Mino release assays. Antibacterial activity is evaluated using the zone of inhibition (ZOI), turbidity, and colony counting assays, while biocompatibility is assessed through a SEM analysis of cell morphology and CCK-8 assay. The results show that the Mino-modified coating is successfully fabricated on the PEEK surface, achieving sustained Mino release for up to 14 days. Among the three Mino concentrations, the PEEK-0.5Mino group demonstrates the best balance of antibacterial activity and biocompatibility, highlighting its potential for preventing IAIs in orthopedic and dental applications. Full article

Implant-associated infections represent challenging complications following orthopedic surgeries, with spinal fixation procedures being particularly linked with increased risks. Thus, urgent research is required to develop enhanced solutions to avoid bacterial colonization, associated implant failure, and severe issues. Our study is based on the laser coating of surfaces with a composite mixture of PLA/Fe₃O₄@CEF that can fight against infectious agents and preserve their activity for a prolonged time. In the present study, we synthesized Fe₃O₄@Ceftriaxone (CEF) nanoparticles by co-precipitation and blended them into polylactic acid (PLA)-based coatings that were thoroughly evaluated from physicochemical and biological points of view. The novelty of this work is the dual functionality of these coatings, combining localized, sustained antibiotic delivery with enhanced biocompatibility for spinal screw applications. The coatings exhibited substantial anti-biofilm effects, reducing Staphylococcus aureus colonization from 1.8 × 10⁸ to 1.6 × 10⁵ CFU/mL and Pseudomonas aeruginosa from 1.2 × 10¹¹ to 1.9 × 10⁶ CFU/mL after 24 h. Furthermore, in vitro assays with murine preosteoblasts and human osteoblasts demonstrated excellent biocompatibility, maintaining >95% cell viability and showing no significant cytotoxicity or inflammatory response. These results highlight the potential of PLA/Fe₃O₄@CEF composite coatings in preventing implant-associated infections and promoting osseointegration, offering a multifunctional strategy for improving spinal fixation screw longevity and patient outcomes. Full article

Titanium implants are widely used in biomedical applications due to their excellent mechanical properties and biocompatibility. However, implant-associated bacterial infections and suboptimal osseointegration remain significant challenges. Recent studies have demonstrated that the interplay between micro- and nanostructures can enhance both biocompatibility and antibacterial properties. This study explores the synergistic effects of hierarchical and dual surface topography on Ti surfaces with micro- and nanostructures to demonstrate their ability to promote cellular biocompatibility and osteoinduction while simultaneously inhibiting bacterial colonization. The combination of selective laser melting (SLM) to create micro-structured surfaces and hydrothermal processes is used to generate distinctive nanopillar structures. By integrating nanoscale features that mimic the extracellular matrix with microscale topographies that influence cellular responses, we achieve a balance between enhanced osseointegration and antimicrobial performance. The physicochemical properties of these dual-scale topographies are characterized through cellular assays using dental pulp stem cells (DPSCs), demonstrating sustained support for long-term cell viability (above 78% in MTT and NR assays (p < 0.05), low levels of LDH release, and high levels of cellular migration) and osteoinduction (statistically significant (p < 0.0001) ALP activity increase and higher levels of calcified matrix deposition, upregulation of ALP and OCN genes compared with smooth surface topographies). Their antibacterial properties against S. aureus and E. coli showed a significant reduction (p < 0.05) in bacterial attachment and biofilm formation. Our findings highlight the potential of multi-scale surface modifications as a promising strategy for next-generation titanium implants, paving the way for improved clinical outcomes in orthopedic and dental applications. Full article

The management of septic orthopedic patients, particularly those with periprosthetic joint infections (PJIs) and trauma-related sepsis, remains a significant clinical challenge. This retrospective cohort study evaluated 27 patients admitted to the Intensive Care Unit (ICU) at the Emergency University Hospital in Bucharest between 2021 and 2024. Patients presented with either PJIs or polytrauma-related infections requiring critical care interventions. The PJI-TNM classification system was employed to assess infection complexity, comorbidities, and implant stability. Therapeutic strategies included one- or two-stage revision surgeries and targeted antimicrobial therapy, including the use of antibiotic-impregnated calcium sulfate beads. Infection resolution was achieved in 85.2% of patients, with a mean ICU stay of 13 days. The overall ICU mortality rate was 11%, with two deaths occurring within the first 30 days of admission. Elevated SOFA scores (≥10) and poor glycemic control (HbA1c > 8.5%) were significantly associated with prolonged ICU stays and higher complication rates. Statistical analysis revealed significant differences in CRP normalization and bone healing times across glycemic control groups (p < 0.001). Patients requiring mechanical ventilation exhibited longer ICU stays and increased mortality (25%). The PJI-TNM classification showed potential utility for risk stratification and guiding personalized treatment strategies. These findings underscore the importance of multidisciplinary ICU-level care and metabolic control in improving outcomes for septic orthopedic patients. Future multicenter studies are needed to validate these preliminary observations and refine prognostic models for this high-risk population. Full article

The goal of this study was to evaluate the clinical outcomes, safety, and clinical applications of bioabsorbable magnesium-based materials for fixation in bone surgeries. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases, followed by manual and reference searches. The articles selected were evaluated for patient characteristics, biocompatibility, the need for revision surgery, bone union rates, and the incidence of gas formation associated with implant degradation. Out of the 631 initially identified articles, 8 studies including a total of 386 patients were included in the final qualitative analysis. The magnesium (Mg) group carried a lower rate of revision surgery (1/275) when compared to the titanium (Ti) group (18/111). A high rate of bone union was found in the Mg group and a low infection rate (3/275) was found in the Mg group. The serum level of Mg and calcium (Ca) were not found to be affected. Mg implants are applied in various orthopedic surgeries but they are not applied in in oral or maxillofacial surgeries. Mg implants appear to be a safe alternative for bone fixation and are resorbable. Future research into the application of Mg implants in bone fixation in different anatomical sites is essential to fully harness their potential benefits for patients. Full article

Orthopedic implant-associated infections are a growing problem. These infections are often associated with bacterial biofilms, such as those formed by Staphylococcus aureus. Nanotextured surfaces can reduce or prevent the development of bacterial biofilms and could help reduce infection rates and severity. Previous work has shown that a carbon-infiltrated carbon nanotube (CICNT) surface reduces the growth of S. aureus biofilms. This work expands on previous experiments, showing that the topography of the CICNT, rather than its surface chemistry, is responsible for the reduction in biofilm growth. Additionally, the CICNT surface does not reduce biofilm growth by killing the bacteria or by preventing their attachment. Rather it likely slows cell growth, resulting in fewer cells and reduced biofilm formation. Full article

Background: Intra-articular calcaneal fracture (CF) treatment is associated with a high risk of complications, but closed reduction and internal fixation (CRIF) is a minimally invasive alternative for treatment. Methods: Forty-eight patients treated with CRIF and CALCAnail^® due to intra-articular CF between 2016 and 2021 were analyzed to check union time, complication rate, and functionality after the intervention. Functional and pain outcomes were assessed, including the Maryland Foot Score (MFS), American Orthopedic Foot & Ankle Society (AOFAS) scale questionnaires, and the numerical pain scale (NRS) at mid-term follow-ups 2–5 years after the intervention. Results: Intervention increased median Böhler’s angle from 21.5° to 32° (p < 0.01). The median bone union time was 12 weeks. The risk of malunion was higher in patients with Sanders type 4 (RR = 2.28; 95% CI 1.11–4.72) and those operated on later than the 2nd day after injury (RR = 2.1; 95% CI 1.08–4.09). Patients with at least one of the comorbidities (nicotinism, diabetes, obesity) had a higher risk of intensive pain (NRS > 3) 2–5 years after surgery (RR = 1.69; 95% CI 1.06–2.68), and 84% were satisfied with their treatment. Other complications included complex regional pain syndrome in two patients (4%), malunion in three (6%), and surgical site infection in two (4%). The MFS had a median score of 85 points, while that of the AOFAS was 82 points. Conclusions: CRIF, with the use of the CALCAnail^® implant, allows doctors to restore anatomical relationships around the subtalar joint, resulting in good clinical and functional results. Full article

This review explores the latest advancements in enhancing the biocompatibility and antibacterial properties of implantable structures, with a focus on titanium (Ti) and its alloys. Titanium implants, widely used in dental and orthopedic applications, demonstrate excellent mechanical strength and biocompatibility, yet face challenges such as peri-implantitis, a bacterial infection that can lead to implant failure. To address these issues, both passive and active surface modification strategies have been developed. Passive modifications, such as altering surface texture and chemistry, aim to prevent bacterial adhesion, while active approaches incorporate antimicrobial agents for sustained infection control. Nanotechnology has emerged as a transformative tool, enabling the creation of nanoscale materials and coatings like TiO₂ and ZnO that promote osseointegration and inhibit biofilm formation. Techniques such as plasma spraying, ion implantation, and plasma electrolytic oxidation (PEO) show promising results in improving implant integration and durability. Despite significant progress, further research is needed to refine these technologies, optimize surface properties, and address the clinical challenges associated with implant longevity and safety. This review highlights the intersection of surface engineering, nanotechnology, and biomedical innovation, paving the way for the next generation of implantable devices. Full article

Multidrug (MDR) and extensive drug (XDR) resistance in Gram-negative bacteria (GNB) emerges worldwide. Although bone and joint infections are mostly caused by Gram-positive bacteria, mainly Staphylococci, MDR GNB substantially increase also as a complication of hospitalization and previous antibiotic administration. This narrative review analyzes the epidemiological trend, current experimental data, and clinical experience with available therapeutic options for the difficult to treat (DTR) GNB implicated in bone and joint infections with or without orthopedic implants. The radical debridement and removal of the implant is adequate therapy for most cases, along with prompt and prolonged combined antimicrobial treatment by older and novel antibiotics. Current research and clinical data suggest that fluoroquinolones well penetrate bone tissue and are associated with improved outcomes in DTR GNB; if not available, carbapenems can be used in cases of MDR GNB. For XDR GNB, colistin, fosfomycin, tigecycline, and novel β-lactam/β-lactamase inhibitors can be initiated as combination schemas in intravenous administration, along with local elution from impregnated spacers. However, current data are scarce and large multicenter studies are mandatory in the field. Full article

Background: Implants are integral to modern orthopedic surgery. The outcomes are good, but infections remain a serious issue. Staphylococcus aureus (S. aureus), along with Staphylococcus epidermidis, are predominant pathogens responsible for implant-associated infections, as conventional antibiotic treatments often fail due to biofilm formation or the pathogens’ ability to invade cells and to persist intracellularly. Objectives: This study therefore focused on interactions of S. aureus isolates from infected implants with MG63 and SaOS2 osteoblasts by investigating the adhesion, invasion, and the impact on the bioenergetics of osteoblasts. Methods and Results: We found that the ability of S. aureus to adhere to osteoblasts depends on the isolate and was not associated with a single gene or expression pattern of characteristic adhesion proteins, and further, was not correlated with invasion. However, analysis of invasion capabilities identified better invasion conditions for S. aureus isolates with the SaOS2 osteoblastic cells. Interestingly, metabolic activity of osteoblasts remained unaffected by S. aureus infection, indicating cell survival. In contrast, respiration assays revealed an altered mitochondrial bioenergetic turnover in infected cells. While basal as well as maximal respiration in MG63 osteoblasts were not influenced statistically by S. aureus infections, we found increased non-mitochondrial respiration and enhanced glycolytic activity in the osteoblasts, which was again, more pronounced in the SaOS2 osteoblastic cells. Conclusions: Our findings highlight the complexity of S. aureus-host interactions, where both the pathogen and the host cell contribute to intracellular persistence and survival, representing a major factor for therapeutic failures. Full article